While the withdrawal rate was low during the initial LED period (10%), withdrawal during the subsequent follow-up period was 33%, which is higher than that reported in other published studies including people with obesity and people with T2DM who are treated with insulin.33 34 The reasons for this are unclear and could relate to the differing patient populations or different study protocols, that is, delivery through referral to a specialised LED company compared with delivery through a secondary care clinical setting or the greater volume of study visits within this protocol. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.